Virginia Commonwealth University Research Articles

REPORTING MERIT-BASED INCENTIVE PAYMENT SYSTEM LIKE DATA IN A UNIQUE AGE-FRIENDLY HEALTH CARE SETTING

Abstract The Richmond Health and Wellness Program (RHWP) offers screening, education, care coordination, and resources as an enhancement to primary care for older adults in five low-income apartment buildings and in a community center. Participants may receive primary care through multiple healthcare systems in the region that do not have a common electronic medical record (EMR). To track age-friendly workflows to the Health Resources Services Administration (HRSA) in the domains of advance care planning, falls prevention, and high-risk medication use, case note documentation in a REDCap database is used to generate Merit-based Incentive Payment System (MIPS)-like data. We report on advance care plans developed, fall risk screenings and risk reduction interventions implemented, high-risk medications screened, and referrals to primary care for high-risk medication deprescribing, including risk reduction with opioid use. When reporting MIPS data to HRSA, we include a disclaimer for RHWP data defining the numerator and denominator used for the MIPS-like measure calculation. For example, when reporting advance care plan completion, we include “RHWP is a care coordination site and care is not provided at the site. The population includes adults aged 55+ or people (of any age) with disabilities in low-income congregate living facilities and all adults participating in RHWP at the Virginia Commonwealth University Health Hub.” The numerator indicates the number of clients with advanced care plans created, and the denominator indicates the total number of clients seen during the reporting period. This presentation will provide strategies to meet reporting requirements when EMR records are not available.

PUSHING BACK AGAINST AI: USING UNGRADING TO PROMOTE CRITICAL THINKING AND INTRINSIC MOTIVATION

Abstract Ungrading is an innovative pedagogical practice in which instructors give frequent, detailed feedback on students’ work and/or encourage self-evaluation rather than assigning them points or letter grades. Ungrading has been shown to increase students’ intrinsic motivation to learn, their willingness to take intellectual risks, and the quality of their thinking. Prior to the introduction of advanced artificial intelligence (AI) writing in academia, grades were shown to be a motivating factor for cheating. Ungrading removes the pressure of grades, thus making the use of AI and other services including paper writing and test answer sharing less enticing. Ungrading could be key to pushing back against the potential for the advent of artificial intelligence tools, which have many universities “alarmed.” Educators at Virginia Commonwealth University College of Health Professions, supported by their Director of e-Learning, planned and piloted ungrading in one undergraduate and two graduate gerontology courses. Twenty-five students completed pre and post-surveys asking for their reactions to ungrading, if their views had changed as a result of the ungrading pilot, as well as their perceptions of traditional grading schemes. They also completed scaffolded assignments with multiple opportunities for receiving in-depth instructor feedback, rather than grades, at various points during the semester. Faculty journaled their ungrading experience in order to recognize how it can be a disruptive, and at times, uncomfortable practice and as a result, educators can better guide themselves and students through the transition. This presentation will include an Implementation Guide for gerontology faculty who wish to implement ungrading.

Impact of C-reactive protein levels and role of anakinra in patients with ST-elevation myocardial infarction

BackgroundInterleukin-1 blockade with anakinra reduces C-reactive protein (CRP) levels and prevents heart failure (HF) events after ST-segment myocardial infarction (STEMI). The effectiveness of anakinra according to the degree of systemic inflammation in STEMI has not been addressed. MethodsWe analyzed 139 patients from three Virginia Commonwealth University Anakinra Response Trial randomized clinical trials to assess whether CRP levels predicted HF hospitalization or death in patients with STEMI, and if CRP levels influenced the effects of treatment with anakinra. ResultsCRP cut-off levels for prediction of the composite of death or HF hospitalization for CRP at admission, 3 and 14 days were, respectively 6.45 mg/L (100% of sensitivity and 66.1% specificity), 26 mg/L (100% of sensitivity and 78% specificity) and 9.56 mg/L (100% of sensitivity and 80% specificity). More patients with elevated CRP levels died or had a HF hospitalization (5/47 [11%] vs 0/82 [0%], p = 0.004 for CRP at admission; 5/32 [15.6%] vs 0/92 [0%], p < 0.001 for day 3 and 5/26 [19%] vs 0/89 [0%], p < 0.001 for day 14). A greater number of patients treated with anakinra had low CRP levels at 3 and 14 days compared to placebo (Odds Ratio 0.11 [95% IC 0.04–0.28], p < 0.0001 and OR 0.35 [95% CI 0.14–0.86], p = 0.02, respectively). Anakinra significantly prevented death or HF hospitalization in patients with high inflammatory burden (p = 0.04 for admission, p = 0.24 for day 3, and p = 0.05 for day 14). ConclusionPatients with elevated CRP had higher incidence of HF hospitalization or death. Anakinra reduced the number of patients with elevated CRP levels and prevented death or HF hospitalization in patients with elevated CRP levels.

Outcomes of Pharmacist-Led Treatment of Hepatitis C in the Virginia Department of Corrections.

A higher proportion of people in correctional settings have, or are at risk for, hepatitis C virus (HCV) due to socioeconomic factors, mental health concerns, substance use disorders, history of high-risk experiences, and more. Compared with the general population, the prevalence of HCV is 10 times higher among people who are incarcerated. The objective of this retrospective cohort study was to describe the HCV treatment cascade in a pharmacist-led clinic model, from referral through treatment completion and documentation of cure. Pharmacists in the Virginia Department of Corrections, in collaboration with Virginia Commonwealth University, established and led a telemedicine HCV clinic. A total of 1,040 incarcerated individuals with chronic HCV infection were treated between January 2020 and January 2022. In this study, the clinical endpoint was the number of patients achieving a 12-week sustained virological response (SVR12), which is considered cure of an HCV infection. The economic endpoint was total dollars spent per patient to achieve the SVR12. Participants were HCV treatment naïve, positive for HCV genotypes 1-6, not concurrently infected with HIV, and without decompensated liver disease. The overall cure rate was 97% with no discontinuation due to adverse effects. The cost-to-cure ratio was $23,223/person achieving SVR12.

Abstract 16312: Sex-Based Differences in Response to Interleukin-1 Blockade With Anakinra in Patients With ST-Segment Elevation Myocardial Infarction

Introduction: Interleukin-1 blockade with anakinra reduces C-reactive protein (CRP) levels and prevents heart failure (HF) events after ST-segment myocardial infarction (STEMI). Sex-based differences in STEMI patients have been reported, but no data are available regarding response to anakinra in this setting. Methods: We analyzed sex-based differences in the systemic inflammation (CRP levels) and composite end-point of new-onset HF or death in patients with STEMI from three different Virginia Commonwealth University Anakinra Response Trial (VCU-ART) randomized clinical trials. Data are reported as median and interquartile range [IQR] or number and percentage (%). Kaplan-Meier curves for event-free survival were constructed for the time-dependent composite endpoint and compared using the log-rank analysis. Results: We analyzed 139 patients from three VCU-ART trials, 29 (21%) were women while 110 (79%) were men. Baseline CRP was higher in women compared to men (8.9 [5.2-13.5] vs 4.2 [2.1-7.7] mg/L, P&lt;0.001). Twenty-two (75%) women and 62 (56%) men were treated with anakinra. Area under the curve (AUC)-CRP at 14 days was numerically lower in patients receiving anakinra versus placebo both in men (86 [37-130] vs 223 [119-374] mg day/L) and in women (73 [46-313] vs 242 [102-988] mg day/L) (P&lt;0.001 at ANOVA for multiple groups, P for interaction 0.22) Figure A . The incidence of the composite endpoint was also numerically lower in the anakinra group compared to placebo, both in men (4 [6.4%] vs 14 [29.1%]) and in women (3 [13.6%] vs 2 [28.5%]) (P=0.019 at ANOVA, P for interaction 0.44) Figure B . There were no statistically significant differences between women and men in AUC-CRP and HF events when comparing separately the anakinra and placebo groups (all P&gt;0.05). Conclusions: Women were underrepresented in the VCU-ART trials, they appeared to have higher CRP levels at time of presentation, yet to benefit similar to men by treatment with anakinra in STEMI.

Response to interleukin-1 blockade with anakinra in women and men with ST-segment elevation myocardial infarction.

Interleukin-1 blockade with anakinra reduces high-sensitivity C-reactive protein (hsCRP) levels and prevents heart failure (HF) events after ST-segment myocardial infarction (STEMI). Sex-based differences in STEMI patients have been reported, but no data are available regarding response to anakinra. We analyzed the systemic inflammation and composite end-point of new-onset HF or death in women and men with STEMI treated with anakinra from three different Virginia Commonwealth University Anakinra Response Trial (VCUART) randomized clinical trials. We analyzed 139 patients, 29 (21%) were women while 110 (79%) were men. Baseline hsCRP was higher in women compared to men (8.9 [5.2-13.5] vs. 4.2 [2.1-7.7] mg/L, P<0.001). Eighty-four patients were treated with anakinra (22 [75%] women and 62 [56%] men). The area under the curve of hsCRP (hsCRP-AUC) after 14 days was numerically lower in patients receiving anakinra versus placebo both in men (86 [37-130] vs. 223 [119-374] mg day/L) and in women (73 [46-313] vs. 242 [102-988] mg day/L) (P<0.001 for multiple groups, P for interaction 0.22). The incidence of the composite endpoint was also numerically lower in the anakinra group compared to placebo, both in men (4 [6.4%] vs. 14 [29.1%]) and in women (3 [13.6%] vs. 2 [28.5%]) (P=0.019 for multiple groups, P for interaction 0.44). There were no statistically significant differences between women and men in hsCRP-AUC and death or HF events when comparing separately the anakinra and placebo groups (all P>0.05). Women were underrepresented in the VCUART trials, they appeared to have higher hsCRP levels at time of presentation, yet to benefit similar to men by treatment with anakinra in STEMI.

Racial disparities in ALS diagnostic delay: a single center's experience and review of potential contributing factors.

Outcomes for amyotrophic lateral sclerosis (ALS) patients are improved with prompt diagnosis, earlier initiation of disease-modifying treatments, and participation in a multidisciplinary clinic. We studied diagnostic delay and disease severity at time of clinic presentation between Black and non-Hispanic Caucasian ALS patients. We performed a retrospective analysis of non-Hispanic Caucasian and Black ALS patients seen in the Virginia Commonwealth University Health System multidisciplinary ALS clinic between 2017 and 2023. Diagnostic delay, ALS Functional Rating Scale-Revised (ALSFRS-R) and upright forced vital capacity (FVC) scores at baseline appointment were collected. Patient's distance from clinic and affluency of residential neighborhood were evaluated. We analyzed 172 non-Hispanic Caucasian and 33 Black ALS patients. Black patients had a 64% increase in diagnostic delay compared to non-Hispanic Caucasian patients. Black patients had a lower performance on ALSFRS-R (5.3 points, p < 0.001) and FVC (17.9 percentage points p < 0.001) at time of first clinic visit. Black patients lived closer to clinic, with higher proportion living in the city of Richmond, but in less affluent areas with lower median house income ($55,300 ± 22,600 vs $69,900 ± 23,700). Our findings demonstrate a large racial difference in ALS diagnostic delay, and greater disease severity and lower respiratory function at time of diagnosis for Black ALS patients. Delay in diagnosis prolongs access to disease-modifying therapies, multidisciplinary care, durable medical equipment, and respiratory and nutritional support. Potential sources of these racial disparities include providers' implicit bias and structural racism.

Cardiovascular impact of near complete estrogen deprivation in premenopausal women with breast cancer: The CROWN study

Survival with operable breast cancer has improved markedly in recent decades, however, treatment-related cardiovascular toxicities threaten to offset these gains. Ovarian function suppression paired with aromatase inhibition, for premenopausal women with hormone receptor (HR)-positive breast cancer, is a newer widely adopted therapy with the potential for significant long-term cardiovascular toxicity. Abrupt estrogen deprivation for non-cancer reasons is associated with accelerated coronary artery disease. Women with breast cancer treated with aromatase inhibition in addition to ovarian function suppression experience a dual hit with regards to estrogen exposure. The CaRdiac Outcomes With Near-complete estrogen deprivation (CROWN) study seeks to understand the early, subclinical natural history of cardiovascular compromise in young women undergoing near-complete estrogen deprivation (NCED) therapy. It is critical to understand the early subclinical development of cardiovascular disease to identify a window for therapeutic intervention before overt cardiovascular events occur. This three-site regional study (Atrium Health Wake Forest, Duke, and Virginia Commonwealth University) uses serial stress cardiac magnetic resonance (CMR) imaging and cardiac computed tomography angiography (CCTA) obtained during the initial two years of NCED therapy to study myocardial prefusion reserve (MPR), large cardiovascular vessel changes, left ventricular function, and other cardiovascular parameters. The CROWN cohort will consist of 90 premenopausal women with breast cancer, 67 with HR-positive disease receiving NCED and 23 comparators with HR-negative disease. Participants will undergo three annual CMR scans and two CCTA scans during the two-year study period. After initial activation hurdles, accrual has been brisk, and the study is expected to complete accrual in December 2024. Efforts are in place to encourage participant retention with the study primary outcome, change in MPR between the two groups, to be reported in 2026-2027. The results of this study will enable premenopausal women with breast cancer to balance the health burdens of cancer at a young age and treatment-related cardiovascular morbidity. Finally, the tools developed here can be utilized to study cardiovascular risk across a range of cancer types and cancer therapies with the ultimate goals of both developing generalizable risk stratification tools as well as validating interventions which prevent overt cardiovascular compromise.

Cultivating Relationships as a Community-Based Recruitment Strategy in Transdisciplinary Aging Research: Lessons From an Academic-Community Partnership.

Participation of Black American older adults in community-engaged research remains challenging in health sciences. The objectives of this study were to describe the specific efforts, successes, and challenges in recruiting Black American older adults in research led by the Health and Wellness in Aging Across the Lifespan core, part of the Virginia Commonwealth University Institute for Inclusion, Inquiry, and Innovation (iCubed). We conducted a cross-case analysis of 6 community-engaged research projects using the community-engaged research continuum model. Successful recruitment strategies comprised a multifaceted approach to community-based collaboration, including a wellness program with a long standing relationship with the community, engaging key stakeholders and a community advisory board, and building a community-based coalition of stakeholders. Posting flyers and modest monetary compensation remain standard recruitment strategies. The cross-case analysis offered critical lessons on the community's nature and level of engagement in research. Relationship building based on trust and respect is essential to solving complex aging issues in the community.

Merging cultures and disciplines to create a drug discovery ecosystem at Virginia commonwealth university: Medicinal chemistry, structural biology, molecular and behavioral pharmacology and computational chemistry.

The Department of Medicinal Chemistry, together with the Institute for Structural Biology, Drug Discovery and Development, at Virginia Commonwealth University (VCU) has evolved, organically with quite a bit of bootstrapping, into a unique drug discovery ecosystem in response to the environment and culture of the university and the wider research enterprise. Each faculty member that joined the department and/or institute added a layer of expertise, technology and most importantly, innovation, that fertilized numerous collaborations within the University and with outside partners. Despite moderate institutional support with respect to a typical drug discovery enterprise, the VCU drug discovery ecosystem has built and maintained an impressive array of facilities and instrumentation for drug synthesis, drug characterization, biomolecular structural analysis and biophysical analysis, and pharmacological studies. Altogether, this ecosystem has had major impacts on numerous therapeutic areas, such as neurology, psychiatry, drugs of abuse, cancer, sickle cell disease, coagulopathy, inflammation, aging disorders and others. Novel tools and strategies for drug discovery, design and development have been developed at VCU in the last five decades; e.g., fundamental rational structure-activity relationship (SAR)-based drug design, structure-based drug design, orthosteric and allosteric drug design, design of multi-functional agents towards polypharmacy outcomes, principles on designing glycosaminoglycans as drugs, and computational tools and algorithms for quantitative SAR (QSAR) and understanding the roles of water and the hydrophobic effect.

The relationship between palliative radiotherapy and opioid prescribing patterns among patients with metastatic cancer.

While randomized trials have established that palliative radiotherapy, especially to bone, can improve qualitative measures of pain, its quantitative relationship to opioid prescribing patterns has remained underexplored. We aimed to identify the association of palliative radiotherapy on opioid prescriptions received among patients with metastatic cancer. The Virginia Commonwealth University Institutional Review Board approved retrospective analysis extracted prescription data from all adult patients with metastatic cancer who underwent outpatient palliative external beam radiation therapy at Virginia Commonwealth University Health System from 2008-2018. Institutional prescribing data were used to calculate the average opioid oral morphine milligram equivalent (MME) dose 30, 60 and 90 days both before and after radiotherapy. Univariate and bivariate ordinary least squares (OLS) regression models were used to estimate the relationship of MME changes with clinical, radiation-related, and demographic patient factors. A total of 182 patients met inclusion criteria. Overall, patients required higher opioid doses after radiotherapy, with mean MME 30, 60, and 90 days prior to radiotherapy of 24.6, 20.2, and 16.8 mg, respectively; which increased to 62.9, 77.7 and 82.4 mg post-radiation therapy (P<0.01). Multivariate OLS models predicting the change of MME 60 days pre- and post-radiation treatment showed that younger age and comorbid depression predicted increased MME after radiotherapy. Patients with metastatic cancer face a relatively high opioid burden, which increases over time, even among those who receive palliative radiation therapy. Patients who are younger and have comorbid depression may have a higher risk of increased opioid burden after radiotherapy.

Effect of clear aligner attachment design on extrusion of maxillary lateral incisors: A multicenter, single-blind randomized clinical trial

Extrusion of maxillary lateral incisors during aligner treatment is a difficult movement to achieve accurately. Despite recommendations regarding attachment design, few studies and no prospective trials compare predictability among attachments. This study aimed to compare the efficacy between optimized and horizontal attachment designs for achieving maxillary lateral incisor extrusion during clear aligner treatment. The study included maxillary lateral incisors in 3 orthodontic practices requiring at least 0.3 mm of extrusion during the first series of 20-25 aligners in patients aged ≥16 years who were scheduled to begin clear aligner treatment (Invisalign; Align Technology, San Jose, Calif). Teeth were randomly assigned to receive optimized (O), rectangular horizontal nonbeveled (H), rectangular horizontal incisally-beveled (HIB), or rectangular horizontal gingivally-beveled (HGB) attachments. After the first series, a blinded evaluator measured extrusion using superimpositions with initial and predicted models. Linear models determined the difference in the predicted extrusion percentage achieved on the basis of attachment design. Other covariates were patient age, sex, number of trays, and self-reported compliance. Forty patients (74teeth) were enrolled, and 38 patients (71 teeth) completed the study. Intraexaminer and interexaminer reliability for extrusion measurements was high (intraclass correlation coefficient, 0.985 and 0.991, respectively). The achieved extrusion was significantly less than predicted (mean, 73%; P<0.0001). The average achieved extrusion was 62%, 79%, 78%, and 78% for O, H, HIB, and HGB attachments, respectively, with H significantly more effective than O (P= 0.0403). Horizontal attachments (H, HIB, and HGB combined) were significantly more effective than O attachments (P= 0.0060), with an average difference in achieved extrusion of 14% of the predicted amount (95% confidence interval, 4-23; estimated 76% vs 62%). Horizontal attachments were an estimated 22% more effective than O attachments for extruding maxillary lateral incisors. Horizontal attachments are more effective than O attachments for predicted maxillary lateral incisor extrusion between 0.3 and 2.5 mm. The 3 horizontal attachment designs evaluated performed similarly for achieving predicted extrusion. This randomized clinical trial was registered and reported at clinicaltrials.gov (NCT04968353). The protocol was not published before trial commencement. This study was funded in part by the Alexander Fellowship of the Virginia Commonwealth University School of Dentistry, the Southern Association of Orthodontists, and the Virginia Orthodontic Education and Research Foundation. No funding source influenced the study design, the collection, analysis or interpretation of data, writing of the report, or the decision to submit the article for publication.

Teaching through Technology: The Virtual Curation Laboratory as a Campus Center for Experiential Learning at Virginia Commonwealth University, Richmond, Virginia

Teaching through Technology: The Virtual Curation Laboratory as a Campus Center for Experiential Learning at Virginia Commonwealth University, Richmond, Virginia

Feminism-in-Action: Dr. Diana Scully.

This essay is a tribute to the former founding Department Chair of Women's Studies at Virginia Commonwealth University, Dr. Diana Scully, by Liz Canfield, a current Associate Chair of the same department.

Adapting Compassionate Conversations for Virtual Mediated Communication

The Covid-19 pandemic resulted in a shift in communication of difficult, emotionally charged topics from almost entirely in-person to virtual mediated communication (VMC) methods due to restrictions on visitation for safety. The objective was to train residents in VMC and assess performance across multiple specialties and institutions. The authors designed a teaching program including asynchronous preparation with videos, case simulation experiences with standardized patients (SPs), and coaching from a trained faculty member. Three topics were included - breaking bad news (BBN), goals of care / health care decision making (GOC), and disclosure of medical error (DOME). A performance evaluation was created and used by the coaches and standardized patients to assess the learners. Trends in performance between simulations and sessions were assessed. Four academic university hospitals - Virginia Commonwealth University Medical Center in Richmond, Virginia, The Ohio State University Wexner Medical Center in Columbus, Ohio, Baylor University Medical Center in Dallas, Texas and The University of Cincinnati in Cincinnati, Ohio- participated. Learners totaled 34 including 21 emergency medicine interns, 9 general surgery interns and 4 medical students entering surgical training. Learner participation was voluntary. Recruitment was done via emails sent by program directors and study coordinators. A statistically significant improvement in mean performance on the second compared to the first simulation was observed for teaching communication skills for BBN using VMC. There was also a small but statistically significant mean improvement in performance from the first to the second simulation for the training overall. This work suggests that a deliberate practice model can be effective for teaching VMC and that a performance evaluation can be used to measure improvement. Further study is needed to optimize the teaching and evaluation of these skills as well as to define minimal acceptable levels of competency.

Multimodal Deep Learning Methods on Image and Textual Data to Predict Radiotherapy Structure Names

Physicians often label anatomical structure sets in Digital Imaging and Communications in Medicine (DICOM) images with nonstandard random names. Hence, the standardization of these names for the Organs at Risk (OARs), Planning Target Volumes (PTVs), and ‘Other’ organs is a vital problem. This paper presents novel deep learning methods on structure sets by integrating multimodal data compiled from the radiotherapy centers of the US Veterans Health Administration (VHA) and Virginia Commonwealth University (VCU). These de-identified data comprise 16,290 prostate structures. Our method integrates the multimodal textual and imaging data with Convolutional Neural Network (CNN)-based deep learning approaches such as CNN, Visual Geometry Group (VGG) network, and Residual Network (ResNet) and shows improved results in prostate radiotherapy structure name standardization. Evaluation with macro-averaged F1 score shows that our model with single-modal textual data usually performs better than previous studies. The models perform well on textual data alone, while the addition of imaging data shows that deep neural networks achieve better performance using information present in other modalities. Additionally, using masked images and masked doses along with text leads to an overall performance improvement with the CNN-based architectures than using all the modalities together. Undersampling the majority class leads to further performance enhancement. The VGG network on the masked image-dose data combined with CNNs on the text data performs the best and presents the state-of-the-art in this domain.

HINT, a code for understanding the interaction between biomolecules: a tribute to Donald J. Abraham.

A long-lasting goal of computational biochemists, medicinal chemists, and structural biologists has been the development of tools capable of deciphering the molecule-molecule interaction code that produces a rich variety of complex biomolecular assemblies comprised of the many different simple and biological molecules of life: water, small metabolites, cofactors, substrates, proteins, DNAs, and RNAs. Software applications that can mimic the interactions amongst all of these species, taking account of the laws of thermodynamics, would help gain information for understanding qualitatively and quantitatively key determinants contributing to the energetics of the bimolecular recognition process. This, in turn, would allow the design of novel compounds that might bind at the intermolecular interface by either preventing or reinforcing the recognition. HINT, hydropathic interaction, was a model and software code developed from a deceptively simple idea of Donald Abraham with the close collaboration with Glen Kellogg at Virginia Commonwealth University. HINT is based on a function that scores atom-atom interaction using LogP, the partition coefficient of any molecule between two phases; here, the solvents are water that mimics the cytoplasm milieu and octanol that mimics the protein internal hydropathic environment. This review summarizes the results of the extensive and successful collaboration between Abraham and Kellogg at VCU and the group at the University of Parma for testing HINT in a variety of different biomolecular interactions, from proteins with ligands to proteins with DNA.

Optical Bioimaging and Therapy

Optical Bioimaging and Therapy

0676 Sleep medication prescribing among patients receiving opioid use disorder treatment with comorbid insomnia

Abstract Introduction People initiating treatment for opioid use disorder (OUD) report insomnia to be a high priority, and insomnia is associated with compromised OUD treatment outcomes. However, insomnia treatments have yet to be investigated in the OUD clinical setting. Knowledge of prescribing patterns for sleep medications among OUD treatment patients is an essential first step to advance therapeutic development at the insomnia-OUD comorbidity. This retrospective cohort study used administrative claims data from IBM MarketScan Commercial and Multi-State Medicaid databases (2006-2016) to investigate the prevalence of insomnia medication prescriptions among patients in OUD treatment with buprenorphine. In doing so, we assess sex differences in prescription receipt within this unique patient population, given the known sex-based disparities in insomnia among other adult populations. Methods We included people aged 12-64 years with diagnoses of insomnia and OUD initiating buprenorphine during the study timeframe. The primary outcome was receipt of insomnia medication prescription within 60 days of buprenorphine start, encompassing benzodiazepines, Z-drugs, or non-sedative/hypnotic insomnia medications (e.g., hydroxyzine, trazodone, and mirtazapine). Descriptive analyses present prescription prevalence for the total sample as well as separately for males and females. Lastly, associations between sex and insomnia medication prescription receipt were estimated using Poisson regression models. Results Our sample included 9,510 individuals (female n=4,637; male n=4,873) initiating buprenorphine for OUD who also had insomnia, of whom 6,569 (69.1%) received benzodiazepines, 3,891 (40.9%) Z-drugs, and 8,441 (88.8%) non-sedative/hypnotic medications. Poisson regression models, adjusting for sex differences in psychiatric comorbidities, found female sex to be associated with a slightly increased likelihood of prescription receipt: benzodiazepines (risk ratio [RR], RR=1.17 [1.11-1.23]), Z-drugs (RR=1.26 [1.18-1.34]), and non-sedative/hypnotic insomnia medication (RR=1.07, [1.02-1.12]). Conclusion Sleep medications are commonly being prescribed to individuals with insomnia in OUD treatment, especially females. These findings juxtapose the known increased overdose risk with benzodiazepine use and lack of efficacy data for these pharmacologic insomnia treatments in this growing patient population in the opioid crisis. Support (if any) National institute of Drug Abuse: K23 DA053507 (CEM), UG1DA050207 (FGM). National Institutes of Health: R25 MH112473-01 (HP), T32 DA015035 (KYX), R21 DA044744 (RAG and LJB). National Center for Advancing Translational Sciences: UL1 TR002345 (Washington University), UL1TR002649 (Virginia Commonwealth University)

Outcomes of Cancer Patients with COVID-19: The Virginia Commonwealth University Experience

Purpose The cancer population is significantly impacted by coronavirus disease 2019 (COVID-19) due to inherent risks of infection imposed by malignancy and therapeutic agents. Evaluating risk factors in this group will lead to improved guidelines for the treatment of malignancy in the setting of a COVID-19 pandemic. Patients and methods This retrospective study reviewed 295 inpatient cancer patients positive for COVID-19 between February 2020 and December 2021 to determine specific risk factors of mortality and associated complications. Various patient characteristics were collected to evaluate outcomes in patient death, oxygen requirement, ventilatory support, and increased length of stay. Results 31 (10.5%) of 295 patients died due to COVID-19. Of those that died, the majority had hematologic cancer (48.4%). There was no difference in the odds of death among the cancer groups. Those vaccinated had a reduced risk of death (OR 0.04, CI 0–0.23). Patients with lung cancer (OR 3.69, CI 1.13–12.31), obesity (OR 3.27, CI 1.18–9.27), CHF (OR 2.68, CI 1.07–6.89) were more likely to require ventilation. Those treated with hormonal therapy had higher odds of having a prolonged admission (OR 5.04, CI 1.17–2.53). Otherwise, cancer therapy had no significant difference in any outcome. Conclusion The mortality rate of cancer patients was 10.5%, lower than in other studies. Vaccinations had mortality benefits, but no effect on hypoxia, ventilator use, or LOS. Delaying cancer therapy during peak infection is likely not necessary based on the results of this study. With improved knowledge in the risks of infection and the utility of personalized precautions, both providers and patients can better prepare for another potential wave of COVID-19